Many people don't understand what anxiety disorder really is. Having struggled with it for so long, I often fail to explain what it is like to constantly feel anxious, and how damaging it can be to my overall health, relationship and work. In this post I am going to try to answer one of the most annoying questions a person with chronic anxiety can get: why can't you just calm down. So, if you think it is something you can find valuable for yourself, please follow me.
What is anxiety disorder?
Well, to answer this question we would need to know more about how our brain works, but there is still much more to research in this field.
People who dedicated their life to psychoanalysis can't fully explain what anxiety disorder really is and how it can be treated.
Anxiety is defined as the anticipation of future threat, the emotional response to real or perceived imminent threat1. That is why when we are anxious, it often feels like fear.
Symptoms of generalized anxiety disorder (GAD) are (According to National Institute of Mental Health):
Feeling restless, wound-up, or on-edge
Being easily fatigued
Having difficulty concentrating; mind going blank
Having muscle tension
Difficulty controlling feelings of worry
Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep.1
It might sound familiar, but not everyone who experiences these symptoms has a disorder. People can get anxious from time to time. But only those experiencing these symptoms for a prolong period of time (over 6 months) are usually diagnosed with anxiety disorder.
It's worth mentioning that anxiety disorder isn't a new phenomenon. Ancient Greek and Latin authors reported cases of pathological anxiety and identified them as medical disorders2.
What are the causes of GAD?
Exact causes of this condition are unknown, however main groups of factors are:
Genetics or history of anxiety in the family
Stress and psychological trauma
Some physical health conditions.
Born like this
In my anxiety story I shared that I have always been an anxious person. I am sensitive to what is going on around me and often react with the burst of worry and fear. I jokingly say that in my previous life I could have easily been a rodent.
GAD is a heritable condition with a moderate genetic risk (heritability of approximately 30%, according to research)3. However, the same research found out that childhood trauma and external stressors (daily stressors from family environment to natural disasters) also influence GAD.
Do I have family members who have anxiety disorder or any other mental illness? It is hard to say, because previous generations are not necessarily open about their mental health. All I know is that my parents used to have some issues with alcohol, which is enough for me to assume that they used it to cope with whatever they were going through at the time.
All I am trying to say is that our background does increase our chances of having a mental illness. However, it doesn’t mean that we are “genetically doomed”, and in my opinion it should not define the progress of our recovery.
Our inner conflicts and anxiety
I started my journey to recovery by learning more about the theory of neurosis (this term is no longer used, but it basically stands for anxiety disorder).
German psychoanalyst Karen Horney developed one of the best theories for this condition. She believed that neurosis resulted from basic anxiety caused by interpersonal relationships4.
Basic anxiety is a feeling of being helpless, abandoned, and endangered in a hostile world. To resolve basic anxiety, a person may “overuse” coping strategies, which in turn leads to anxiety disorder.
Through years of self-analysis I have come to the conclusion that my anxiety originated from my "compliant personality". A person with the compliant personality tries to move toward other people, expressing needs for approval and affection.
We may develop neurotic tendencies depending on how we were treated in our childhood (maybe even trauma), however it is possible that other factors impact our predisposal to cope with basic anxiety in an unhealthy way.
Let’s talk about them.
Stress and anxiety
Once my therapist told me that our resilience is something, we as human beings are born with, and there is no way to improve it. I really had hard time believing it, as I always try to improve. I don't like to be told that it's just the way it is. However, I think she was right to a certain extent. I am not the most resilient person, and even though I have been working on myself for many years, I am still very much prone to get easily stressed.
Although the role of stress in developing anxiety disorders isn't clear, there are studies that show that stressful event or a persistent and chronic disorder can cause secondary biological changes in specific brain structures, that in turn can be the reason for anxiety.
If I look back, I started to develop anxiety disorder when I was in college. I have always been a "worrier", but those stressful years of sleepless nights, pressure from family and friends made it even worse. I developed a strong morning anxiety and was not able to calm down for a long time afterwards.
According to experts, when someone experiences a stressful event, the amygdala (an area of the brain that contributes to emotional processing) sends a distress signal to the hypothalamus, so the person has the energy to fight or flee5.
Experiencing chronic stress, the body makes more cortisol (hormone that controls stress response, blood glucose levels, inflammatory responses, and blood pressure) than it releases. High levels of built-up cortisol can wear down the brain’s ability to function properly. According to several studies, chronic stress can disrupt synapse regulation, resulting in the loss of sociability and the avoidance of interactions with others. Stress can kill brain cells and even reduce the size of the brain. Chronic stress also has a shrinking effect on the prefrontal cortex (the area of the brain that is responsible for memory and learning)6.
Cortisol can create a domino effect that hard-wires pathways between the hippocampus and amygdala which makes the brain more predisposed to being in a constant state of fight-or-flight aka more receptive to stress7.
In fact, studies show that during acute psychological stress extracellular Gamma aminobutyric acid (GABA) decreases8.
GABA is an important amino acid that works as a neurotransmitter in our brain. It produces a calming effect by attaching to a special protein (known as GABA receptor) in our brain.
There is more information on the subject available in literature, that is more complex. As I am not a doctor, I will stop here, but the bottom line is that there is so much to anxiety disorder than not having enough will power to relax. A person having this condition simply cannot relax due to undeniably complex changes in the brain.
I am what I eat
The relationship between anxiety and medical illness can range from autonomic abnormalities producing the syndrome of anxiety (i.e. hyperthyroidism) to medical illness mimicking anxiety disorder. It would be different from a person to person.
For example, dysbiosis and inflammation of the gut have been linked to causing several mental illnesses including anxiety and depression, however more research is needed to completely understand how exactly gut health impacts mental health9.
As I have previously shared, some medications can even make anxiety worse.
What I find interesting, is that a new study revealed correlation between what we eat and anxiety disorders10. “For those who consumed less than three sources of fruits and vegetables daily, there was at least at 24% higher odds of anxiety disorder diagnosis,” says the lead author.
Researchers explain that a poor diet may increase body fat, therefore systemic inflammation, that has previously been linked to anxiety and depression11. However until we have more data, it is hard to say what exactly causes inflammation and how it impacts our brain’s function including our ability to manage stress.
Can't calm down
As we can see, anxiety can be caused by different factors, most likely I didn’t cover all of them in this blogpost. But what I want you to understand that most likely it’s a combination of factors that make people predisposed to having anxiety disorder and other mental illness, and it won’t be just one thing that will help them cope with it.
Many people might think that by knowing the reason, we can simply get rid of anxiety; if we are tired, we just need to rest. However, neurosis is deeply ingrained in our personality as well as it is a result of the "disordered" brain functioning. Understanding it better may help dealing with it, not necessarily get rid of it completely.
Telling a person with anxiety disorder to calm down is like saying: stop having a headache.
1 U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Anxiety disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
2 Crocq MA. A history of anxiety: from Hippocrates to DSM. Dialogues Clin Neurosci. 2015;17(3):319‐325; <https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml>
3 Gottschalk MG, Domschke K. Genetics of generalized anxiety disorder and related traits. Dialogues Clin Neurosci. 2017;19(2):159‐168; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/>
4 Karen Horney: An Overview, <http://gavsappsychpersonalitylandpatel.weebly.com/karen-horney.html>
5 Harvard Health Publishing Understanding the stress response, article, March 2011 <https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response>
6 Ecole Polytechnique Fédérale de Lausanne. (2014, September 18). How stress tears us apart: Enzyme attacks synaptic molecule, leading to cognitive impairment. ScienceDaily. Retrieved May 20, 2020 from www.sciencedaily.com/releases/2014/09/140918091418.htm
7 Christopher Bergland, Psychology Today, Chronic Stress Can Damage Brain Structure and Connectivity, article, February 2014, <https://www.psychologytoday.com/us/blog/the-athletes-way/201402/chronic-stress-can-damage-brain-structure-and-connectivity>
8 Hasler G, van der Veen JW, Grillon C, Drevets WC, Shen J. Effect of acute psychological stress on prefrontal GABA concentration determined by proton magnetic resonance spectroscopy. Am J Psychiatry. 2010;167(10):1226‐1231. doi:10.1176/appi.ajp.2010.09070994 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107037/
9 Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E, Wakefield S. Gut microbiota's effect on mental health: The gut-brain axis. Clin Pract. 2017;7(4):987. Published 2017 Sep 15. doi:10.4081/cp.2017.987 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/
10 Maria Cohut, Ph.D, Medical News Today, New study reevaluates factors linked with anxiety disorders, article, March 3, 2020, <https://www.medicalnewstoday.com/articles/new-study-reevaluates-factors-linked-with-anxiety-disorders>
11 Jason M. Peirce, Karina Alviña, The role of inflammation and the gut microbiome in depression and anxiety, review, May 2019, <https://onlinelibrary.wiley.com/doi/abs/10.1002/jnr.24476>